Echinococcus multilocularis is a cestode parasites that frequently occurs in the red fox (Vulpes vulpes), which is the main definitive host in Central Europe. The parasite may infect humans as accidental intermediate hosts and cause alveolar echinococcosis. In the German federal state of Saxony-Anhalt, the occurrence of E. multilocularis in red foxes as a possible source of infection for humans was studied from 1998 to 2010. A significant shift in the geographical centroid of the occurrence of E. multilocularis from a long-known highly endemic area in the southwest of the state towards the north-northeast (3.2 km/year) was found. The overall prevalence in the state increased significantly from 13.6% (1998–2005) to 23.4% (2006–2010). No autochthonous cases of alveolar echinococcosis have been reported to date in Saxony-Anhalt, but this might change in the near future with the spread and increasing biomass of the parasite.